Shared Decision-Making July 18, 2016

Shared Decision-Making

by Janet L. Cummings, Psy.D

Recently, in CGI’s weekly Biodyne Grand Rounds, which is our weekly case conference amongst faculty and students, our newest faculty member, Dr. Wendy Boring-Bray, gave a dynamic presentation on shared decision-making. She explained that this model views patients and medical providers as members of the same team. Patients have a “voice” and make their own healthcare decisions, once their healthcare providers have armed them with the information they need to make wise choices. Dr. Wendy shared a lot of excellent materials that can be used to help patients understand the pros and cons, and risks vs. benefits, of various healthcare decisions they may need to make.

The theory and practice of shared decision-making resonated with me. Dr. Wendy shared things that have been part of the Biodyne Model all along. For example, the Biodyne Basic Therapeutic Contract, which we make with our patients, states explicitly that we are partners in meeting the patient’s goals and in making the therapist obsolete. Before we embark on trying to affect change in our patients, we ensure that the goals we have in mind are the patient’s goals and not just our own. We assign homework, as this permits our patients to take ownership of their goals and progress toward them.

Even though the Biodyne Model has always employed these principles, we have never had a name for them. Dr. Wendy provided that for us. The term “shared decision-making” puts a name on what we’ve always done.

I have practiced shared decision-making in my personal healthcare for many years now. I ask questions, lots of questions, and do my own research. I learn as much as I can about my medical issues, and then engage in a partnership with my physicians to make the best possible decisions. I don’t tolerate the paternalistic approach in which a doctor tells a patient what is going to happen and what the patient must do.

I got to thinking that healthcare and education are not all that different, and perhaps the principles of shared decision-making apply to education as well as to healthcare. In fact, we have been using the principles of shared decision-making at CGI since the very beginning. We just didn’t have a name for what we were doing until Dr. Wendy gave us one.

Our Doctor of Behavioral Health students are bright, competent professionals, who typically come to us with about ten years of clinical experience. They know what they want from their DBH educations, and they know where they want to go in their careers. There’s no way that these brilliant and assertive people are going to let us dictate what they need or even insinuate that we know what they need better than they do.

We listen to our students. We don’t just pay lip service, but we genuinely listen and try to understand their needs and wants. We have made many changes in response to what our students tell us. For example, our students told us that our internship program was obsolete, as they were already working in medical settings and could not leave their paid jobs to work for free in an internship. We actually re-wrote our curriculum accordingly. Many prospective students told us they could not afford our tuition, and our current students told us they were struggling to pay their tuition. So, we lowered tuition, and not just by a minimal amount. We slashed it.

I sincerely hope that the healthcare of the future is a system that respects patients and encourages them to share in medical decision-making. I also hope that the future of education is a system that respects students and encourages them to be active voices with regard to their educational needs. I believe that CGI is going to help fulfill both my wishes, as we encourage our students to take active roles in their educational decision-making and train them to engage patients in shared decision-making.

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Testimonials

The “four questions” of the refocused psychotherapist [in the Biodyne Model] and the concept of the “onion/garlic” psychodynamic enabled me to not only conceptualize a case and plan treatment more rapidly, but to rise to a new level of professional confidence in meeting the behavioral care needs of my patients.

Dr. Gayle Cordes, DBHJuly 12, 2016

The DBH program has been life-changing for me and has brought great value to the patients I serve. I work with a diverse population of patients in a 400+ bed Hospital to improve overall health outcomes. I love working with other medical providers to help patients improve their wellness and quality of life. I collaborate with the medical team to treat behavioral and psychological components of COPD, CHF, Diabetes, weight loss, stress, anxiety, depression, insomnia, IBS, substance abuse issues, and more. The DBH program’s focus on brief interventions in medical settings is valuable, timely, and effective.

At the age of 53, and after working 25 years in the field of social work returning to school was not on my bucket list, but after learning about the Cummings Graduate Institute’s online program, my hope of achieving my lifetime a doctorate degree was possible. CGI online Doctor of Behavioral Health program is innovative and relevant. It's the perfect fit for the busy professional, parent or person looking to return to school or career advancement without the fuss of unnecessary coursework. CGI understands and recognizes that there are capable professionals and that most professionals are looking to gain a competitive edge or simply looking to satisfy a personal goal.

Steven ByrdDBH Candidate, Cummings Graduate InstituteMarch 4, 2017

I am a behavior analyst, and always believed that behavior analysis could improve the quality of life of so many people; but the way ABA services are delivered nowadays, one behavior analyst cannot reach many people. The healthcare landscape is changing and integration is a perfect venue to reach more people. I had already worked in a hospital setting and knew that my training was not enough to navigate the changing systems. The DBH offers training in relevant subjects such as population health management, health equity, legal issues and ethics in healthcare, and entrepreneurship. The breadth and variety of the courses will prepare me to face any challenges I may encounter.

The faculty at CGI are not only very knowledgeable in their field, but are very caring individuals who make an effort to learn about the students and their interests. I have been pleasantly surprised by the various systems CGI has in place to set clear expectations and guidelines for the student's performance. For each class, I know exactly what to expect, and what I have to do. The course material is very stimulating and engaging. The staff is very approachable and responsive, and the Librarian is an asset! I feel that everyone at CGI is cheering me for my success while holding me accountable for my work. I am sure that upon graduation, I will have a solid foundation to be an active change agent in the healthcare landscape.

CGI has changed my life, all for the better. Because I have the DBH program listed on my resume, the Senators (my Senate Confirmation Hearing to serve on the New York State Board of Parole) wanted to know all about the program in each hearing. I was questioned by New York Senate Board members to explain the DBH program, and the 'DBH' title. Everyone appears to be excited to have someone on the Board with behavioral experience. My goal is to use the education and skills acquired at CGI to improve behavioral health services throughout the New York correctional system.
Presently, within the NYS correctional system, primary care and behavioral health care are siloed, with no interaction across boundaries. The integration of care will support inmates while in prison, and will ensure appropriate treatment upon release, thus reducing recidivism rates among the formerly incarcerated.